| NPI | 1487113452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME166028) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: FL ME166028) |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2024-07-02 |